本期由湖北省卫生健康委员会和湖北广播电视台联合策划。
对于大部分人来说，一谈起血液肿瘤，最先想到的就是白血病，韩剧里很多“生死恋”都因它而上演。但其实，还有一种血液病，它的发病率超过白血病，仅次于淋巴瘤，是血液系统第二大常见恶性肿瘤。很多患者的首发症状是腰疼、贫血、肾功能损害、反复感染……这些症状很难与血液病联系到一起，所以误诊、漏诊率非常高，85%的患者确诊时已是晚期！它就是——多发性骨髓瘤！今天我们就来聊一聊，如何识别善于“伪装”的骨髓瘤？精彩预告??本期专家
医院院长
华中科技大学血液病学研究所所长
介绍：主任医师、二级教授、博士生导师。全国*协委员、国家重点学科带头人、教育部新世纪百千万人才、国家杰出青年科学基金获得者、国家科技进步二等奖获得者、全国创新争先奖、卫生部有突出贡献中青年专家、国务院*务特殊津贴获得者。在各种疑难血液病的临床诊治方面具有丰富经验，特别是对出、凝血疾病如难治ITP、易栓症等，恶性血液疾病如多发性骨髓瘤等具有较深造诣。
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初次误诊率高达60%！你听说过多发性骨髓瘤吗？多发性骨髓瘤是一种起源于浆细胞的恶性肿瘤。正常的浆细胞会产生抗体，这种抗体在机体的免疫功能方面发挥着重要作用。当浆细胞成为恶性细胞时，它们就会变得具有多形性和不可控制地增长。从而对人体产生全方位、多系统的损害。多发性骨髓瘤是血液科的常见病和疑难病之一，且起病隐匿。再加上这一疾病的知晓率目前还是比较低，所以导致很多患者跑错科室，被漏诊、误诊，初次漏诊率高达60%，很多患者会首先就诊于骨科和肾内科等其他科室，诊断历程非常长，通常要4-6个月确诊。很多患者因此错过了最佳治疗时间，严重影响预后效果。02
腰疼、贫血、肾功能损害、反复感染……有可能是骨髓瘤？一、腰疼骨痛≠骨病约75％的骨髓瘤患者因骨痛而就诊，约80％患者有不同程度的骨损害。骨头中有成骨细胞，还有破骨细胞，正常情况下，两者的代谢维持在一个平衡状态。当患有多发性骨髓瘤时，恶变的浆细胞会使钙、磷代谢发生变化，导致破骨细胞活动能力变强，成骨细胞活动能力下降。代谢平衡打破后，骨质被破坏，骨强度下降，很多患者就会出现骨痛。二、厌食恶心呕吐≠消化系统疾病多发性骨髓瘤会导致体内血钙水平增高，大量的钙质析出进入血液，排泄不出去，会出现高钙血症。高钙血症对人体损害严重，可引起头痛、厌食、恶心、呕吐、多尿、便秘，重者可致心律失常、嗜睡、意识模糊、谵妄或昏迷。三、肾功能异常≠肾病40%的患者会合并肾功能损害，部分会发展为急性肾功能衰竭，甚至需要做血液透析。恶变的浆细胞产生大量的单克隆抗体，就是M蛋白。M蛋白太多后，排泄不出去，堵塞肾小管，时间长了以后肾小球会出问题，进而损害肾功能。很多病人一开始往往在肾科就诊，甚至被当成肾病治疗，耽误时机，发展为肾衰竭。肾衰竭是骨髓瘤的重要并发症，与早期病死率增加有关，需要及时和适宜的干预治疗。四、乏力头晕脸色差≠内分泌疾病当恶变的浆细胞无限增殖，挤占了正常的骨髓空间，导致骨髓不能正常生成红细胞，甚至白细胞、血小板时，就会出现贫血。从而产生乏力、头晕、活动后心悸气短、面色苍白等表现。五、呼吸道感染≠呼吸道疾病恶性浆细胞分泌的M蛋白是没有免疫功能的，所以多发性骨髓瘤的患者往往免疫力低下，容易感染，感染后不易控制，控制后易复发，比如反复发作肺炎，或者出现带状疱疹等。提问
确诊骨髓瘤要做哪些检查？
胡院长：一般需进行血尿蛋白电泳和免疫固定电泳，骨髓穿刺，影像学等检查可明确诊断。高危人群检查建议——40岁以上人群，如出现不明原因的骨痛、头晕、乏力、蛋白尿、水肿、反复感染等，在对应专科正规诊疗无效，需引起医院血液科检查。
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自体移植打破治疗困境多发性骨髓瘤不再是绝症过去，多发性骨髓瘤曾一度缺乏有效治疗手段。近十几年来，随着医学技术的进步，化疗、靶向治疗、免疫治疗等新方法的涌现，骨髓瘤的疗效有很大提高。完全缓解率从5%提高到70%，平均生存期可以超过5年，早期的患者经过积极治疗以后中位生存期可以超过10年，甚至有患者能达到30年。多发性骨髓瘤是以化疗为主的一个多学科综合治疗，涉及靶向药治疗、自体造血干细胞移植、支持治疗等。对于适合移植的多发性骨髓瘤患者，会先通过化学药物进行诱导治疗，让患者达到一定的缓解程度后，再根据患者身体情况判断是否能够进行造血干细胞移植（就是把患者自己的造血干细胞拿出来做移植）进行巩固治疗。最后通过药物的巩固和维持治疗，尽可能延长患者的生存期。点击边框调出视频工具条amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;nbsp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;mpchecktextcontenteditable=amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;falseamp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;id=amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am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血液疾病的认知误区很“坏事”这些谣言你信了吗？说法一：住刚装修的房子易得恶性血液肿瘤。错误！新装修的房子，乳胶漆中的苯和大理石中的放射线，这两种有害物质与血液肿瘤具有一定的相关性。但现在的装修材料，环保等级有所提升，目前也没有明确证据表明，只要住了刚装修的房子，就会得血液肿瘤。建议新装修的房子多通通风再入住。孕妇、婴幼儿、老年人等体质较弱的人群不建议入住新装修的房子。说法二：血液肿瘤有遗传性。错误！有小部分血液肿瘤呈家族聚集性发病，直系亲属患病几率会比正常人有所增加，不过不是肯定会遗传的。说法三：患上肿瘤疾病要少摄入蛋白质，“饿死”癌细胞。错误！确实有一些传言“癌症不能吃糖、高蛋白、高营养，不能吃鸡……”，这些想“饿”死癌细胞的理论，都是不科学的。想饿死癌细胞，同时也是饿坏了好的免疫细胞，不利于患者的身体恢复。均衡营养合理膳食才是增强体质抵御疾病的正确之道。多发性骨髓瘤患者的饮食禁忌：如合并肾脏问题，可以吃一些碱性的食物，减少尿蛋白对肾脏损伤，比如豆腐、牛奶、海带等。另外，要多喝水，让M蛋白都尿出去，减少在肾里的堆积，减少对肾小管的损伤。
说法四：患上恶性血液肿瘤最好少动，容易受伤出血。错误！这个说法也是比较片面的，适当运动，可以提高免疫力。不过需要提醒的是，多发性骨髓瘤患者免疫功能有缺陷，容易感染，所以要避免扎堆，预防交叉感染。年龄大的患者还要特别注意预防骨折。来源：荆楚大医生、湖北省卫生健康委员会、湖北广播电视台往期回顾：
做人，不要看不起任何人
抽脂≠减肥！33岁“网红”抽脂后感染去世，官方通报……
常吃碘盐和海鲜，会导致甲状腺结节？甚至甲状腺癌？！
目前+人已